25 November 2004

Curious. But until they say something about the effects of the brain-shrink, not all that useful.

Pain causes an unexpected brain drain, according to a new study in which the brains of people with chronic backaches were up to 11 percent smaller than those of non-sufferers.

People afflicted with other long-term pain and stress might face similar brain shrinkage, said study leader A. Vania Apkarian of Northwestern University.

The results suggest those with constant pain lose gray matter equal to an oversized pea for each year of pain. Gray matter is an outer layer of the brain rich in nerve cells and crucial to information and memory processing.

The results don't reveal why the brain shrinks, but it might involve degradation of neurons, which are the signal transmitters of the mind and body.

"It is possible it's just the stress of having to live with the condition," Apkarian told LiveScience. "The neurons become overactive or tired of the activity."

Another possibility is that people born with smaller numbers of neurons are predisposed to suffering chronic pain. But some of the differences measured "must be directly related to the condition," Apkarian said.

The research involved a one-time brain scan of 26 people who'd had unrelenting back pain for at least a year (and in one case for up to 35 years), along with a pain-free control group. Pain sufferers had lost 5 to 11 percent of gray matter over and above what normal aging would take away.

"People who have had pain for longer times have had more brain atrophy," Apkarian said.

No attempt was made to correlate brain size to brain function. It is possible that some of the shrinkage involves relatively noncrucial tissue -- other than neurons -- and that some of the effects are reversible if the pain is eliminated, Apkarian and colleagues write in the Nov. 23 issue of the Journal of Neuroscience.

Apkarian said other varieties of pain might cause a similar atrophy of gray matter, and he plans to study that possibility in future studies.

"Suffering of pain is fundamentally an emotional condition," Apkarian said. "Different types of pain will have different types of emotional parameters, which will probably result in different types of atrophy -- different amounts and in different brain regions." Link

14 November 2004

Another great bit from the UCLA online exhibit (and apologies to my readers whom this bores --as you well know, until fame, I use this blog to record tidbits that interest me for further use).

Since 1973, the multidisciplinary pain clinic has come into its own. Many clinics now offer a variety of therapeutic approaches to effective pain management, including physical therapy, acupuncture, TENS (transcutaneous electronic nerve stimulation), hypnosis, and behavioral modification based on the methods pioneered by Bonica's colleague, Wilbert Fordyce. However, not all patients have access to good pain clinics and, in the US, many pain therapies are not covered by insurance.

Richard Sternbach, of the Pain Treatment Center at Scripps Clinic and Research Foundation in La Jolla, offered 7 steps on how to live despite pain in his 1977 pamphlet (How Can I Learn to Live With Pain When It Hurts So Much?, revised in 1983):

1. Accept the fact of your pain 2. Set specific goals of work, hobbies and social acitivities towards which you will work 3. Let yourself get angry at your pain if it seems to be getting the best of you 4. Pace your activities * Get in shape, and keep fit * Learn to relax, and practice it 5. Time your medications, then taper off them 6. Have family and friends support only your healthy behavior, not your invalidism 7. Be open and reasonable with your doctor

13 November 2004

My friend broke his wrist the other day. In talking to him, I realized that I don't know how the various opiate drugs stack up against each other: i.e., which are stronger and by how much, which last longer, and how they differ in their indications. So I'm on the hunt. First up: oxycodone

He was prescribed Percocet which turns out to be oxycodone and acetaminophen (Tylenol). According to the DOJ,

Oxycodone is an effective analgesic for mild to moderate pain control, chronic pain syndromes, and for the treatment of terminal cancer pain. Five mg of oxycodone is equivalent to 30 mg of codeine when administered orally. Oxycodone and morphine are equipotent for pain control in the normal population; 10 mg of orally-administered oxycodone is equivalent to 10 mg of subcutaneously administered morphine. Oxycodone is considered to be similar to morphine, in all respects, including its abuse & dependence liabilties. Oxycodone in dosages of 5 to 10 mg in combination with acetaminophen or aspirin are abused orally. High dose single entity sustained release formulations containing 10 to 80 mg of oxycodone are abused by crushing or chewing the tablet and then swallowing, snorting or injecting the drug.

Chemistry/Pharmacology

Oxycodone [4,5a-epoxy-14-hydroxy-3-methoxy-17-methylmorphinan-6-one, dihydrohydroxycodeinone] is a semisynthetic opioid structurally related to codeine and is approximately equipotent to morphine in producing opiate-like effects. The first report that oxycodone, sold under the brand name Eukodal, produced a "striking euphoria" and habituation symptoms was published in Germany in the 1920's. While oxycodone is metabolized by the liver to oxymorphone, the physiological and behavioral effects are not related to, nor dependent on, the formation of this metabolic by-product. Link

09 November 2004

After several months of intermittent banging of my head against this point from Nagel, I still can't decide whether I think he's deeply right, or deeply wrong. Anyway, its worth drawing attention to because it is extremely important for how we understand impersonal (agent-neutral) reasons for alleviating pain and the source of the reasons each has to alleviate her own pains.

When the objective self contemplates pain, it has to do so through the perspective of the sufferer, and the sufferer's reaction is very clear. Of course he wants to be rid of this pain unreflectively -not because he thinks it would be good to reduce the amount of pain in the world. But at the same time his awareness of how bad it is doesn't essentially involve the thought of it as his. The desire to be rid of the pain has only the pain as its object. This is shown by the fact that it doesn't even require the idea of oneself in order to make sense: if I lacked or lost the conception of myself as distinct from other possible or actual persons, I could still apprehend the badness of pain immediately. So when I consider it from an objective standpoint, the ego doesn't get between the pain and the objective self. My objective attitude toward pain is rightly taken over from the immediate attitude of the subject, and naturally takes the form of an evaluation of the pain itself, rather than merely a judgment of what would be reasonable for its victim to want: "This experience ought not to go on, whoever is having it." To regard pain as impersonally bad from the objective standpoint does not involve the illegitimate suppression of an essential reference to the identity of its victim. In its most primitive form, the fact that it is mine -the concept of myself- doesn't come into my perception of the badness of my pain. View from Nowhere, p.161

05 November 2004

I finally submitted the fellowship application I've been sweating over for the past month and a half. When I returned to the precis I thought I had finished (the precis I had posted here), I realize it needed to me sexier. Here's the new version. Again, I'm curious what you think (for long comments, try using the twin site at www.dolor.blog-city.com or emailing me).

Pain is a fundamental evil. Understanding pain and its place in human life is a fundamental religious and ethical concern. From Pandora, to Job, to the Buddhists' first Noble Truth that all life is suffering, to modern secular questions about the value of life, all philosophical and religious traditions have struggled with pain's evil. From the source of our moral obligations and our understanding of what makes life good, to the role of suffering in redemption and the idea of a just god, making sense of pain is making sense of humanity. Yet, despite its central place in our understanding of ourselves and of what matters most, virtually everyone has misunderstood what pains are and therefore wherein their evil lies. I shall give a new account of both.

This is a dissertation on pain's intrinsic badness. It is also a dissertation on the nature and sources of value. The account I shall give yields insights into perennial philosophical questions including, inter alia, the ubiquity of reasons to alleviate other's pains; the nature of rationality; the role of subjective desire in ethics; the possibility of reducing value to natural properties; the value of autonomy; the nature of torture; and the normative significance of animals' pain.